Journal of Current Glaucoma Practice

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VOLUME 17 , ISSUE 1 ( January-March, 2023 ) > List of Articles


Efficacy of Endotrabeculectomy (Trabecula Ablation Ab Interno with the Forceps) for Open-angle Glaucoma

Ihor Y Novytskyy, Markiyan I Novytskyy

Keywords : Endotrabeculectomy, Intraocular pressure, Phacoemulsification, Primary open-angle glaucoma, Prospective non-randomized cohort study

Citation Information : Novytskyy IY, Novytskyy MI. Efficacy of Endotrabeculectomy (Trabecula Ablation Ab Interno with the Forceps) for Open-angle Glaucoma. J Curr Glaucoma Pract 2023; 17 (1):15-21.

DOI: 10.5005/jp-journals-10078-1389

License: CC BY-NC 4.0

Published Online: 13-05-2023

Copyright Statement:  Copyright © 2023; The Author(s).


Aim: To investigate the efficacy of endotrabeculectomy (ETE) performed either alone or combined with phacoemulsification (phaco) in patients with primary open-angle glaucoma (POAG). Materials and methods: Investigations were done in two groups. The first group (38 patients, 38 eyes) with POAG underwent ETE, and the second group of 126 patients (126 eyes) with POAG and cataracts underwent ETE and phaco. The hypotensive effect of the surgery was evaluated. Results: In the ETE group, the mean intraocular pressure (IOP) was reduced from 20.25 ± 3.30 to 14.94 ± 1.95 mm Hg (26.2% reduction, p < 0.001) at 12 months. The number of medications was reduced from 2.8 ± 1.0 to 1.5 ± 1.0 (p < 0.001) at 12 months after the surgery. In the phaco-ETE group, the mean IOP was reduced from 18.24 ± 3.20 to 14.83 ± 1.71 mm Hg (18.7% reduction, p < 0.001) at 12 months. The mean number of medications was reduced from 2.2 ± 1.1 to 1.0 ± 1.0 (p < 0.001) at 12 months after the surgery. The success rate defined as a final IOP of <16 mm Hg using the Kaplan–Meier curve at 12 months was 73.8%. There were no complications that led to a constant visual decrease. Clinical significance: Our study shows that ETE is technically simple, gives the ability to remove trabecula in any quadrant, and effectively reduces IOP in patients with POAG. Conclusion: Endotrabeculectomy (ETE) is a safe and relatively simple procedure that significantly reduces IOP. The minimally invasive nature of the ETE allows expanding indications for combined treatment of glaucoma and cataract.

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  1. Watson PG, Grierson I. The place of trabeculectomy in the treatment of glaucoma. Ophthalmology 1981;88(3):175–196. DOI: 10.1016/s0161-6420(81)35051-9
  2. Moster MR. Trabeculectomy post-op: staying on track. Rev Ophthalmol 2013:1–18.
  3. Rulli E, Biagioli E, Riva I, et al. Efficacy and safety of trabeculectomy vs nonpenetrating surgical procedures: a systematic review and meta-analysis. JAMA Ophthalmol 2013;131(12):1573–1582. DOI: 10.1001/jamaophthalmol.2013.5059
  4. Edmunds B, Thompson JR, Salmon JF, et al. The National Survey of Trabeculectomy. III. Early and late complications. Eye (Lond) 2002;16(3):297–303. DOI: 10.1038/sj.eye.6700148
  5. King AJ, Rotchford AP, Alwitry A, et al. Frequency of bleb manipulations after trabeculectomy surgery. Br J Ophthalmol 2007;91(7):873–877. DOI: 10.1136/bjo.2006.109835
  6. Palejwala N, Ichhpujani P, Fakhraie G, et al. Single needle revision of failing filtration blebs: a retrospective comparative case series with 5-fluorouracil and mitomycin C. Eur J Ophthalmol 2010;20(6):1026–1034. DOI: 10.1177/112067211002000624
  7. Li F, Tang G, Zhang H, et al. The effects of trabeculectomy on pseudoexfoliation glaucoma and primary open-angle glaucoma. J Ophthalmol 2020;2020(2):1723691. DOI: 10.1155/2020/1723691
  8. Carassa RG, Bettin P, Fiori M, et al. Viscocanalostomy versus trabeculectomy in white adults affected by open-angle glaucoma: a 2-year randomized, controlled trial. Ophthalmology 2003;110(5):882–887. DOI: 10.1016/S0161-6420(03)00081-2
  9. Lopes AS, Vaz FT, Henriques S, et al. Outcomes of trabeculectomy with and without mitomycin C in pseudoexfoliative glaucoma compared with mitomycin C in primary open angle glaucoma. Med Hypothesis Discov Innov Ophthalmol 2019;8(2):73–80.
  10. Godfrey DG, Fellman RL, Neelakantan A. Canal surgery in adult glaucomas. Curr Opin Ophthalmol 2009;20(2):116–121. DOI: 10.1097/ICU.0b013e32831eef65
  11. Francis BA, Singh K, Lin SC, et al. Novel glaucoma procedures: a report by the American Academy of Ophthalmology. Ophthalmology 2011;118(7):1466–1480. DOI: 10.1016/j.ophtha.2011.03.028
  12. Johnson M. ‘What controls aqueous humour outflow resistance?’ Exp Eye Res 2006;82(4):545–557. DOI: 10.1016/j.exer.2005.10.011
  13. Tam LC, Reina-Torres E, Sherwood JM, et al. Enhancement of outflow facility in the murine eye by targeting selected tight-junctions of Schlemm's canal endothelia. Sci Rep 2017;7(1):40717. DOI: 10.1038/srep40717
  14. Koudouna E, Young RD, Overby DR, et al. Ultrastructural variability of the juxtacanalicular tissue along the inner wall of Schlemm's canal. Mol Vis 2019;25:517–526.
  15. Minckler DS, Baerveldt G, Alfaro MR, et al. Clinical results with the trabectome for treatment of open-angle glaucoma. OphthalmologyOphthalmology 2005;112(9):1540. DOI: 10.1016/j.ophtha.2004.12.043. Erratum in: 2005;112(6):962–967.
  16. Minckler D, Mosaed S, Dustin L, et al. Trabectome (trabeculectomy-internal approach): additional experience and extended follow-up. Trans Am Ophthalmol Soc 2008;106:149–159;discussion 159–160.
  17. Novytskyy I, Novytskyy M. Efficacy of trabecula ablation through anterior chamber angle for open-angle glaucoma. Ophthalmol Jurn 2012;36(2):19–21. DOI: 10.31288/oftalmolzh201221921
  18. Novytskyy IY, Novytskyy MI. Results of combined endotrabeculectomy and phacoemulsification surgery. Vestn Oftalmol 2015;131(3):50–55. DOI: 10.17116/oftalma2015131350-55
  19. Nakasato H, Uemoto R, Isozaki M, et al. Trabeculotomy ab interno with internal limiting membrane forceps for open-angle glaucoma. Graefes Arch Clin Exp Ophthalmol 2014;252(6):977–982. DOI: 10.1007/s00417-014-2616-4
  20. Bendel RE, Patterson MT. Long-term effectiveness of trabectome (ab-interno trabeculectomy) surgery. J Curr Glaucoma Pract 2018;12(3):119–124. DOI: 10.5005/jp-journals-10078-1235
  21. Lee JW, Yick DW, Tsang S, et al. Efficacy and safety of trabectome surgery in Chinese open-angle glaucoma. Medicine (Baltimore) 2016;95(15):e3212. DOI: 10.1097/MD.0000000000003212
  22. Akil H, Chopra V, Huang AS, et al. Short-term clinical results of ab interno trabeculotomy using the trabectome with or without cataract surgery for open-angle glaucoma patients of high intraocular pressure. J Ophthalmol 2017;2017:8248710. DOI: 10.1155/2017/8248710
  23. Chow JTY, Hutnik CML, Solo K, et al. When is evidence enough evidence? a systematic review and meta-analysis of the trabectome as a solo procedure in patients with primary open-angle glaucoma. J Ophthalmol 2017;2017(11):2965725. DOI: 10.1155/2017/2965725
  24. Mizoguchi T, Nishigaki S, Sato T, et al. Clinical results of trabectome surgery for open-angle glaucoma. Clin Ophthalmol 2015;9(default):1889–1894. DOI: 10.2147/OPTH.S83958
  25. Kaplowitz K, Bussel II, Honkanen R, et al. Review and meta-analysis of ab-interno trabeculectomy outcomes. Br J Ophthalmol 2016;100(5):594–600. DOI: 10.1136/bjophthalmol-2015-307131
  26. Bussel II, Kaplowitz K, Schuman JS, et al. Trabectome Study Group. Outcomes of ab interno trabeculectomy with the trabectome after failed trabeculectomy. Br J Ophthalmol 2015;99(2):258–262. DOI: 10.1136/bjophthalmol-2013-304717
  27. Okeke CO, Miller-Ellis E, Rojas M. Trabectome Study Group. Trabectome success factors. Medicine (Baltimore) 2017;96(24):e7061. DOI: 10.1097/MD.0000000000007061
  28. Parikh HA, Bussel II, Schuman JS, et al. Coarsened exact matching of phaco-trabectome to trabectome in phakic patients: lack of additional pressure reduction from phacoemulsification. PLoS One 2016;11(2):e0149384. DOI: 10.1371/journal.pone.0149384
  29. Hashemian SJ, Miraftabi A, Jafari ME, et al. Combined cataract extraction and trabeculotomy by the internal approach for coexisting cataract and open-angle glaucoma. J Curr Ophthalmol 2016;29(1):17–22. DOI: 10.1016/j.joco.2016.09.003
  30. Esfandiari H, Shah P, Torkian P, et al. Five-year clinical outcomes of combined phacoemulsification and trabectome surgery at a single glaucoma center. Graefes Arch Clin Exp Ophthalmol 2019;257(2):357–362. DOI: 10.1007/s00417-018-4146-y
  31. ElMallah MK, Seibold LK, Kahook MY, et al. 12-Month retrospective comparison of kahook dual blade excisional goniotomy with istent trabecular bypass device implantation in glaucomatous eyes at the time of cataract surgery. Adv Ther 2019;36(9):2515–2527. DOI: 10.1007/s12325-019-01025-1
  32. Kornmann HL, Fellman RL, Feuer WJ, et al. Early results of goniotomy with the kahook dual blade, a novel device for the treatment of glaucoma. Clin Ophthalmol 2019;13:2369–2376. DOI: 10.2147/OPTH.S224643
  33. Lee D, King J, Thomsen S, et al. Comparison of surgical outcomes between excisional goniotomy using the Kahook Dual Blade and iStent trabecular micro-bypass stent In combination with phacoemulsification. Clin Ophthalmol 2019;13:2097–2102. DOI: 10.2147/OPTH.S224109
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